Appeals Analyst

Medical Billing and Coding - Coding Audit - Charge entry

Processes and appeals claims denied for coding or medically necessary related reasons. Facilitates accurate coding by providing feedback related to payor denials and policies to coding personnel.

Location: Currently Park Plaza, opportunity for hybrid after training.

Schedule: Monday thru Friday 8am to 5pm.

Hiring Range: $23/hour to $29/hour, commensurate with applicable professional experience.

Essential Functions And Responsibilities

• Provide/support coding reimbursement education to improve providers' coding accuracy and optimize collections.
• Attend and/or conduct periodic coding / charge entry and training sessions as requested.
• Perform trend analysis of coding and medical necessity related denials to conduct process improvements to eliminate/reduce denials
• Review coding and medical necessity related denials to identify patterns for coder and/or provider education and charge edit creation.
• Thoroughly and timely work follow up records related to coding and medical necessity denials in work queues as defined by policies and procedures.
• Appeal denied claims and follow up until resolution.
• Review and appeal payments received that are not paid at levels in accordance with payor contracts.
• Read and interpret EOB's (Explanation of Benefits)
• Present unresolved concerns to Supervisor for resolution immediately with related documentation.
• Document account activity accurately and promptly during or immediately following each processed encounter.
• Responsible for the accurate and timely submission of claims, denials, written appeals, and re-bills of insurance claims.
• Responsible for the analysis and necessary corrections of patient accounts as it relates to coding and medical necessity to submit clean claims or written appeals.
  
  

Education And Skills

• High school diploma or equivalent required.
• AHIMA (CCA, CCS, CCS-, or RHIT); AAPC (CPC, CPC-A, CPC-H, CPC-H-A, or one of the relevant AAPC specialty-specific coding credentials preferred.
• Minimum of three years' experience in medical billing and collections or coding.
• Working knowledge of ICD-10, CPT, and HCPCS coding and Correct Coding Initiatives (CCI) required.
• Knowledge of government, commercial, and third party insurance contract practices and claims processing procedures preferred.
• Ability to interpret insurance medical policies and procedures.
• Demonstrated excellent written and oral communication skills.
• Experience working in a medical office setting required, with demonstrated understanding of standard insurance reimbursement methodologies.
• Ability to educate providers and others regarding coding, documentation requirements, and other relevant processes preferred.
• Knowledge of medical terminology and anatomy required.
• Excellent organizational skills and attention to detail required.
• Must have demonstrated competence with computer systems including electronic health records, and Microsoft Office Suite required.
  
  

Pay Range

$22.42 - $31.38

The above information is intended to indicate the general nature and level of work required in this position. It is not designed to contain or be interpreted as a comprehensive description of all duties, responsibilities, and qualifications required of those assigned to this job.

We offer a competitive Total Rewards Program. Eligibility for benefits is dependent on factors such as position type and FTE. Benefit-eligible employees qualify for benefits beginning on the first of the month following one month of employment. Vancouver Clinic offers medical, dental, vision, life insurance, AD&D, long term disability, health savings account, flexible spending account, employee assistance program, and multiple supplemental benefits (voluntary life, critical illness, accident, hospital indemnity, identity theft protection, legal services, etc.). We also offer a 401k retirement plan, with employer contributions after your first year of employment. Benefits-eligible employees accrue PTO and Personal Time based on hours worked and State worked, totaling 120 hours in the first year for full time staff and 200 hours in the first year for full time supervisors and above, increasing in subsequent years. PTO and Personal Time accruals are pro-rated by FTE/hours worked. Non-benefits eligible employees will accrue Personal Time based on hours worked and State worked. Employees will also enjoy up to six paid holidays per year, depending on schedule. Contact your recruiter for more information.

Vancouver Clinic is proud to be an Equal Opportunity Employer. Vancouver Clinic does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, gender identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Vancouver Clinic is an alcohol and drug-free workplace. Offers are contingent on successful completion of background screen and immunization requirements.